Cure and Hormonal Control After Prolactinoma Resection: Case Series and Systematic Review

Author:

Penn Marisa C1ORCID,Cardinal Tyler1,Zhang Yanchen1,Abt Brittany1,Bonney Phillip A1,Lorenzo Patricia2,Lin Michelle1ORCID,Rosner Jack1,Weiss Martin1,Zada Gabriel13,Carmichael John D23ORCID

Affiliation:

1. Department of Neurosurgery, Keck School of Medicine of USC, Los Angeles, California 90033, USA

2. Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California 90033, USA

3. USC Pituitary Center, Keck School of Medicine of USC, Los Angeles, California 90033, USA

Abstract

Abstract Context Surgical management of prolactinomas is an important treatment for patients intolerant of dopamine agonist therapy. However, predictors of postoperative outcomes remain unclear. Object While transsphenoidal surgical resection (TSSR) is important second-line therapy in prolactinoma patients, predictors of surgical cure and biochemical remission following TSSR remain sparse. Methods A retrospective review of prolactinoma patients undergoing TSSR at the USC Pituitary Center from 1995 to 2020 was conducted. Participants were categorized as surgical cure (normalization of serum prolactin without medical treatment), surgical noncure, biochemical control (prolactin normalization with or without adjuvant therapy), and nonbiochemical control. A systematic review of the outcomes of surgically managed prolactinomas was performed. Results The 40 female and 16 male participants had an average age of 35.6 years. Prior treatment included transsphenoidal resection (6, 11%) and dopamine agonist treatment (47, 84%). The 40 macroadenomas and 15 microadenomas exhibited suprasellar extension (24, 43%) and parasellar invasion (20, 36%). Fifteen (27%) were purely intrasellar. Gross total resection was achieved in 25 patients (45%) and subtotal in 26 (46%). Surgical cure was achieved in 25 patients (46%) and biochemical control in 35 (64%). Surgical cure was more likely in smaller, noninvasive tumors, those that were fully resected, and patients with lower preoperative (< 1000 ng/mL) and immediately postoperative (< 7.6 ng/mL) prolactin levels. Ten of 26 patients (38%) undergoing adjuvant therapy achieved biochemical control, which was less likely in men and those with higher preoperative prolactin or invasive tumors. Conclusion Surgical resection of prolactinomas is a safe procedure that, when offered judiciously, can achieve symptom and/or biochemical control in a majority of patients. A variety of predictors may be useful in advising patients on likelihood of postoperative remission.

Publisher

The Endocrine Society

Subject

Endocrinology, Diabetes and Metabolism

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